Month / June 2008

This hits far too close to home as I called Flagstaff home for 3 years and did my training at Flagstaff Medical Center. Hell, the wife was airlifted out of Flagstaff by Guardian Air (one of the parties involved in the crash). I used to go by the area where they went down, daily ( it’s hard not to in a small town!) It’s far too close, even though I don’t know the victims.

I know that my patient’s chief complaint is C. Difficile colitis, but are you perhaps forgetting his rather substantial cardiac history?The fact he has coronary artery disease, congestive heart failure, has had both an MI and open heart surgery?I realize that his renal function stunk when he was admitted, but do you think it was all that wise to run IV fluids on him continuously for 5+ days?So now, instead of just slight bibasilar crackles like the first night I had him, he now has crackles all the way to under his shoulder blades.That he’s puffy like the Michelin man and we have to prop his scrotum up with towels because it is so edematous.Yes, as a matter of fact his saturations are within normal levels, but he doesn’t seem so peachy.He’s working a little harder to breathe and for the first time in 3 nights, when he got up to the bathroom to have a movement, he had an episode of chest pain, the first in his whole hospitalization.You say “call me if his respiratory status changes” but how about being pro-active and treating the issue before he decompensates and has to stay longer?Yes, I am a nurse, but you see your patients for 5 minutes a day, I’m with them 12 hours at a shot and get to know them, so when I ask if you’ve considered giving a little Lasix, I do have a clue and a reason for asking:I’m seeing a progression here that you and the Team are obviously missing.But I know, it’s nearly the end of June and you’re about to move up a year and have interns of your own, and not have to do the night shift as much anymore, but for now, can you just please treat my patient?

Oh, and while I’m at it, I know you guys have a quota for testing for C.Diff, but think about it before you do.When the you ask about the patients bowel habits and the nurse tells you that, “Well she had a couple loose stools, but days had given her Miralax, colace, senna and milk of mag,” the resulting loose stools is probably not C.Diff, just a side effect of over-medicating with stool softeners.If it was C.Diff, we’d tell you:if it looks like CDiff, acts like C.Diff (24 trips to the toilet in a shift) and mostly, smells like C.Diff, it probably is.If it doesn’t fit, why would you order the tests and the isolation it requires? And to add to that, when you’re sending a patient to my floor, you better tell us in advance that they are being ruled out for C.Diff because we have to give them a private room due to the contact isolation they must be in until they rule out for C.Diff.

I admit it:I’m lazy.I will use whatever I can to make my life easier.Microwave food?Sure.Canned soup instead of from scratch?Any day of the week.Automatic BP machine?A necessity.

Usually the start of the shift involves the staff running out of the report room, like the famed running of the bulls in a frantic search for a Dynamap to call our own.I’m serious; it’s nearly like a food riot some nights, complete with taunting and trash talking.Hell, some folks, will stash machines in empty rooms before going into report just to ensure they have one when they come out.When you look at it though, it’s quite amusing and rather pointless.It’s all about the ease of it.You just wrap the cuff, slap on the sat monitor and hit the “go” button and chat it up with your patient.Easy.

So I wasn’t on my game the other night and didn’t snag one.Standing in the middle of hallway, desperately searching for that blue-colored savior and none were to be seen.All that was left was a lonely old manual cuff on wheels, sitting long-forgotten at the end of the hall.Sighing resignedly, I grabbed it.Went and checked out a portable sat machine and thermometer and went to start rounds.

The first patient looked at the old cart and said, “I haven’t seen one of those forever, y’all seem to only use the automatics all the time.”To which I replied, “Yep, I’m just old-school tonight.”But as the night went on, I came to an epiphany:it worked better.It was quieter, no noisy alarms, no loud start-up sounds, just the old wheels skidding across the linoleum.I even tried an automatic on one patient and it couldn’t find her pulse to take a pressure and ended up flashing “Error” at me.Hooked her up and took it manually and had not an issue.

Now it’s not like I never take manual blood pressures when I have a machine, but admittedly, it is rare.Sure, if I get a reading that is way out of whack, or just doesn’t seem right by machine, I’ll check it by hand.In the last Code I was, in the machine couldn’t get a pressure and I could only get one by palpation.They have their use, but I’m a reconvert to manuals.So call me old-skool, but I’m OK with that.

Someone asked for an update on the six codes from the night into Friday the 13th. I don’t know a whole lot as most of them were not even on my floor, but here is what I do know.

They lost one, after and hour and a half of work. The others I do believe are still in the Unit. The guy we sent had been extubated by the time I came back the next time, but was still still on multiple pressors. I will say though that we have been incredibly busy, full many nights. The other night, excluding L&D, the only open bed in the house was the code bed.

At least we haven’t had a night like that since, and hopefully won’t for awhile.

Anyways, my Internet connection has been and is kind of spotty so if it seems like I disappear for days at a time, I’m OK. Plus, I have 6 days off, and the weather is going to be AWESOME! Who can argue with blue skies, a slight breeze and temps. in the 70-80’s?

While I may be superstitious, my rational side is usually able to concoct an explanation for circumstances of what may seem to be divine intervention, or lack thereof. But I can’t on this one. The only plausible explanation, the only one that makes even a shred of sense is the totally irrational one. How else could you explain 6 codes in 1 night?

Yes, we have sick people, sicker than normal in house right now. But 6 codes? That’s more than a typical week, even more than a typical month. So yes, 6 codes, 4 in the Unit, one upstairs and one on my floor. The code team was looking ragged, the doc looked like she was one of the walking dead herself after being abused all night long. I think our Materials people were going to throw a fit if they had to throw together another fresh code cart. It was one of those nights.

But the explanation you ask? Friday the 13th. It’s the only one that makes any sense at all. Even though it was only the 13th for half of last night, it’s insidious reach kept things interesting. The worst part of it all though is that now, tonight, Mr. Blackcloud (me…) is in charge. I’m calling staffing right now to make sure the ICU is well staffed and checking with Materials to get an extra cart up to my floor, just in case. Let’s hope the universe got it all out of its system last night and things will go smooth.

Yeah, I know some folks do this in a month, a week, a day or hour, but this is just me rattling on and on. Nothing all that ordinary, right? Just my thoughts, feelings and experiences as a nurse.

So to #10,000, who visited sometime on the 31st of May or 1st of June, I thank you. And to all of you that have visited leading up to that 10,000th visit, in the humble words of Apu Nahasapeemapetilon, “Thank you, please come again!”